Is there evidence to support the use of definitive CRT in patients with NSCLC in separate ipsilateral lobes and mediastinal lymph node involvement?

Challenging question. I am not aware of any level I evidence to answer this. In the absence of randomized data, I would allow common sense to prevail. Staging of this went from M1 to T4 from AJCC 6th edition to 7th edition mostly because these patients do better by survival then the traditional stage IV patients, and thus moved to a better stage. Surgeons would argue that if the tumors are in different lobes of the same lung, and nodal disease is N2, then the patient is still resectable. Similar...

I agree, management depends on many factors including: location of ipsilateral nodule, if biopsy has been performed and nodule showed same histology confirming it is not a separate primary, extent of N status, and whether including it in the same radiation field would significantly increase toxicity. At times treating with SBRT would be appropriate perhaps post completion of CRT, again if it can't be technically included in same field. Other times, re-assessment post chemorads and watchful waiti...